Times Change, Ward Rounds Don’t

Ward rounds are crucial elements in any hospital environment. They are routinely being performed, no matter in which country, which day of the week or which medical speciality. Physicians and patients alike either do look forward to them – or they don’t.

Over the past decades the procedure of rounds hardly changed. If you ever get to work in various hospitals, in different countries with different people and different work ethics, you’ll notice that those wards – they all pretty much happen the same way.

An impedimenta of white-coated youngsters follow a single person from room to room. People – mostly females called nurses – accompany the followers, residents open up doors, and often in drill-like ways the patient’s history is being recited right in front of the patient. A procedure that needs training and that heavily varies on the doctor leading the round – be it the grumpy-funny head of department or the newly appointed assistant professor – it largely depends on them if a ward round feels comfortable and fun for all parties involved – the surrounding doctors, nurses and last but not least – the patient in front all of them.

The routine itself, though, is coordinated, hierarchical and follows certain rules. New doctors who join ward rounds in the very beginning often need to pay more attention on how to behave, rather than on the actual reason they are doing the rounds:

Patient interaction

Evaluation of a physical and mental status-quo

Planning of further treatments.

When I look into modern hospitals across the globe, I think that there is a lot of improvement in the way ward rounds are being performed. I have no particular solution, except for obvious “modernization techniques” such as using digital devices instead of paper, on how to optimize rounds, but I think there is potential here for some smart kid out there.

As a modern physician you are being surrounded by computers, technology and helpful – and not so helpful – gadgets. There are analogue (stethoscope) and digital devices (blood gluocse check device) that slowly but progressively infiltrated modern medicine, yet those never seemed to have reached the high art of clinical rounds.

To sum this up: How come the way ward rounds are being performed hasn’t changed for decades? Is it really the best way to assess the afore mentioned on a daily basis (interaction – status quo – planning)?

1 COMMENT

There are a myriad of efforts going on all around the globe… I have implemented robotic telepresence for surgical ICU rounds (click here).

There are many reasons that we don’t see a broad change in how we perform rounds. One is that it isn’t necessarily broken. The second is that you must define that there is a problem, and then implement a solution to that unique problem. For instance, our problem in the ICU was mainly noise and traffic that came with a large multidisciplinary team. Implementing robotic telepresence allowed the team to meet with the patient and nurse virtually. Thus decreasing the team footprint and decreasing noise. A side effect was decreasing the problem of discussing private patient problems in an open ICU where other family and patients could listen.

So, bottom line is.. technology can help. But only if its designed and implemented to solve a finite problem that is definable.